Washington State's Medicaid Program Will No Longer Pay For Unnecessary ER Visits

Washington state's Medicaid program will no longer pay for ER visits deemed medically unnecessary. Elsewhere, Illinois' governor will propose $2 billion in Medicaid cuts, and fallout continues over controversial proposals to reform California's Medicaid Medi-Cal program.

The Seattle Times: State Medicaid Program To Stop Paying For Unneeded ER Visits
Intent on cutting state budget health care costs, Medicaid officials say the program will no longer pay for any medically unnecessary emergency-room visits, even when patients or parents have reason to believe they're having an emergency. The rules — arguably more drastic than an earlier proposal to limit Medicaid patients to three visits per year for nonemergency conditions — would block payment for ER visits for about 500 different conditions. They would apply to all adults and children on Medicaid, with no exceptions, such as someone being brought in by ambulance or from a nursing home, or when patients have neurological symptoms or unstable vital signs (Ostrom, 2/7).

Chicago Sun-Times: Quinn Wants $2 Billion In State Medicaid Cuts
Gov. Pat Quinn said he plans to cut the state's Medicaid spending by $2 billion as a painful but necessary way to attack the state's budget crisis. … Last year Quinn proposed cutting the state's Medicaid budget by $600 million. … What exactly will he cut? Quinn said he would spell that out in his budget address in two weeks. But it involves changing the state's Medicaid program into a "wellness system" instead of a "provider payment system," he said. The problem he faces is that cuts to Medicaid can mean cuts to federal matching funds (Pallasch, 2/8).

The Sacramento Bee: Federal Officials Reject California's Plan To Charge Medi-Cal Co-Payments
Federal health officials rejected California's bid to charge Medi-Cal co-payments for everything from drugs to hospital visits, dealing a new blow to the state budget but relief to low-income patients and their providers. Gov. Jerry Brown and lawmakers relied on mandatory Medi-Cal co-payments to save $511 million in last year's state budget and presumed that the state would continue saving in future years. The plan to charge low-income Medi-Cal patients and let doctors refuse care for nonpayment was unprecedented for a state on such a wide scale (Yamamura, 2/7).

California Healthline: Douglas: Healthy Families Similar to Medi-Cal
Acknowledging that the proposal to shift 875,000 children out of Healthy Families and into Medi-Cal on a relatively fast timeline is a little controversial, [State Department of Health Care Services Director Toby] Douglas said it's part of a bigger plan. "It's all about delivery system reform," Douglas said. "It's about moving toward organized delivery systems" (Gorn, 2/8).

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